SS02 - Carotid Revascularization Improves Mood in Depressed Patients with Advanced Carotid Disease

Objectives: Stroke prevention is the main objective of carotid revascularization in patients with atherosclerotic carotid disease. Ongoing research highlights the impact of carotid interventions on neurocognitive function in patients with advanced carotid atherosclerosis. However, little is known about the impact of carotid revascularization on mood. We aim to investigate the effects of carotid revascularization procedures on depression in a well-defined cohort of patients.

Methods: A total of 158 patients undergoing carotid revascularization were prospectively recruited. Screening for depression was performed pre-operatively, and at 1-,6- and 12-month post-intervention using the long form of the geriatric depression scale (GDS) questionnaire. The cohort was divided into “Depressed” and “Non-depressed” based on a pre-operative GDS score > 9 and ≤ 9 respectively.Patients with a GDS ≥20 were excluded. Patients also received Rey Auditory Verbal learning test (RAVLT) to assess episodic memory function concurrently at the designated time points. RAVLT Z scores were normalized against group means of age-matched Mayo’s older Americans normative studies (MOANS). GDS scaled scores were adjusted for age and education. Paired t-test was performed to compare post-interventional scores at the individual time points with the pre-interventional scores, and independent t-test was used to compare scores between the 2 groups.

Results: At baseline, depression (GDS > 9) was observed in 49(31%) subjects, whereas 109(69%) patients were not depressed (GDS score ≤ 9). The average pre-operative GDS score 15.42 +/-4.40(14.16-16.69) and 4.28 +/-2.89(3.73-4.83) in the depressed and non-depressed groups, respectively. A total of 127 patients with one or more post-operative GDS test were included in the analysis. Interestingly, we observed a significant improvement in GDS scores within the depressed group at 1-month (average=13, p=0.002), 6-months (average=13.2, p=0.027) and 1-year (average=11.6, p< 0.001) post-intervention compared to preop, whereas the non-depressed group had similar post-op GDS scores at all time points compared to baseline. Additionally, preop RAVLT sum memory scores were lower in the depressed group compared to the non-depressed. We observed a significant improvement of immediate recall Z-scores at 6-month postop in both depressed (-0.95 vs -0.46, p=0.001) and non-depressed groups (-0.50 vs. -0.26, p=0.023).

Conclusions: Our study highlights that patients with advanced carotid disease who are depressed have low memory scores and that carotid revascularization improves memory in both depressed and non-depressed patients. However, improvements in mood are only among those who had baseline depression. Further studies with larger sample sizes are warranted to investigate the association between depression, carotid disease, and carotid intervention.